James Garfield And The 'Destiny Of The Republic'

REBECCA ROBERTS, host: July 2nd, 1881 was a beautiful day in Washington, D.C. President James A. Garfield arrived that morning at the Baltimore and Potomac train station on the National Mall eager to get going on a trip to Massachusetts with his sons. He never got on the train. Charles Guiteau, a deranged former lawyer and evangelist who believed Garfield owed him an ambassadorship, stepped out of the shadows and shot the president once in the arm and once in the back. Garfield seemed at first as if he might recover, but then, his doctors got involved.

What happened over the next two months, the desperate and ultimately failed attempt to save the president is the subject of a new book by author Candace Millard. It's called "Destiny of the Republic: A Tale of Madness, Medicine and the Murder of a President." To get a better feel for the story, Candace Millard and I took a field trip.

We're here at the National Museum of Health and Medicine. This is a facility that has existed since the 1860s in various places in Washington and is now in a new home in Silver Spring, Maryland. Candace Millard, what is it that we're looking at here?

CANDACE MILLARD: This is the section of President Garfield's spine that was removed during the autopsy. And it shows - specifically, you can see there's a red pin that goes - and it's a plastic pin - that goes through the spinal column showing where Guiteau's bullet went through.

ROBERTS: Also, looking at it, the way the bullet went through the body of the vertebra instead of through where the spinal cord comes up, he could have survived this bullet wound.

MILLARD: Yes, absolutely. The bullet didn't hit the spinal cord. It didn't hit any vital organs. And, you know, at this time, 16 years after the Civil War, there were a lot of Civil War veterans walking around with bullets inside of them. In fact, one of the detectives who took Guiteau to the district jail after he shot Garfield had a bullet in his head that he'd been walking around with since the Civil War. And so, you know, the problem was the president received a lot of medical care and the wrong kind. In fact, the first time this wound was examined was on the floor of the train station.

ROBERTS: And what eventually killed the president?

MILLARD: Infection. So this examination went on for day after day after day for more than two months. In the end, 12 different doctors inserted unsterilized fingers and instruments in this wound in the president's back searching for this bullet. In fact, they made the track down the right side that they thought was the track of the bullet, but their own fingers and instruments made it, and it filled with pus. And so he went from this, you know, six-foot-tall, 210-pound vigorously healthy man to 130 pounds in less than three months.

ROBERTS: So looking from here - and I'm trying to orient my spine to the president's here on the table - if the bullet went through to the left side of his body, his doctors at the time were pretty convinced it was on the right side. And, in fact, one of the interesting, sort of subplots in your book is Alexander Graham Bell trying to rush to readiness more or less a metal detector to track the path of the bullet, but he wasn't allowed to look in the right place.

MILLARD: That's right. So the doctor who took over his medical care, Dr. Doctor Willard Bliss - whose first name was Doctor strangely - Dr. Bliss believed and had publicly stated that the bullet was on the right side. At first, he thought it was in the liver, and everyone believed that the president would die that night. And when he survived, they said, well, it must be near the liver, but it's still a danger to him, and so that's why we need to find it, and that's why they continued to probe for it. This is 14 years before the invention of the medical X-ray, so they really don't have any other way to look for it. And that's when Alexander Graham Bell stepped in with his induction balance, which was basically a metal detector which he connected to a telephone receiver.

And had he been able to find this bullet, and had they been able to see, it had done all the damage it was going to do. It was no longer a danger to the president, the medical care was. Had he been able to stop that early enough before the infection was too great, the president almost certainly would have survived. So what happened, when they did the autopsy - and the doctors who had taken care of the president were there - they realized immediately how wrong they were. And one of the surgeons who had worked with Bliss stepped forward at this, you know, incredibly painful, emotional autopsy and ran his little finger down the spine and slipped his finger into that hole where you see that pin right now, and he said, we were wrong. We made a mistake. And he walked out the door.

ROBERTS: I'm speaking to Candace Millard. Her book is called "Destiny of the Republic: A Tale of Madness, Medicine and the Murder of a President." When the doctors came to treat Garfield, starting initially on the floor of that filthy train station with their filthy hands, ultimately introducing the infection that would kill him, the theory of antisepsis existed. Why didn't they pay attention to it?

MILLARD: So this is one of the most difficult-to-accept aspects of this story. Joseph Lister, who was a renowned British surgeon, had discovered antisepsis 16 years earlier. He'd had dramatic results in his own surgical lab, and he had begged American doctors to sterilize their hands and instruments. And he had warned them if they didn't, they ran the very real risk of killing their patients.

Unfortunately, many of the most experienced, most respected doctors in the United States dismissed antisepsis. They thought it was useless, maybe even dangerous. And the doctors who were treating the president, you know, the fact that he was president, they thought, we're not going to take any chances. We're going to use the most traditional medical methods of the time. I think had he been just an average man, he would have had a better chance of surviving.

ROBERTS: It's ironic, because the fact that he was the president also pushed people forward scientifically. Alexander Graham Bell tried to perfect the induction balance, but at the same time, it led his doctors to cling to older ways.

MILLARD: That's right. You know, this - you know, people forget that this was a tremendous tragedy at the time, an incredible loss to the country. But one of the good things that came out of it was that antisepsis immediately was accepted and adopted in the United States after Garfield's death. Because after the autopsy results were released, Americans understood right away that their president didn't have to die, and they understood why he did. You know, Dr. Bliss was disgraced, publicly disgraced in newspapers and medical journals. And it was a tremendous advancement in medical science.

ROBERTS: The portrait you paint of Garfield is this, just lovely man, smart and warm and decent and kind even when he was in terrible pain. You clearly grew fond of him writing about him. Do you associate this sort of specimen with him at all? Is this just sort of an interesting artifact, or does that speak to you as part of this great man?

MILLARD: It absolutely does. In fact, it always surprises me - when they brought this section of his spine in again today, it hits me in my heart, you know, because from a distance of 130 years, these great men, these political leaders become almost mythical, I think. And, you know, when you see something like this, it's just a reminder that this was a man. You know, this was a husband. This was a father, a remarkable man, a great man, but a man. And he was only 49 years old and had so much promise and was, you know, beloved. And it's just a reminder that he lived and that his death was a tremendous loss to the country.

ROBERTS: Candace Millard. Her new book is "Destiny of the Republic: A Tale of Madness, Medicine and the Murder of a President." Thank you so much.